Advanced biologics have the potential to improve quality of life of psoriasis patients : Dr. Shehnaz Arsiwala

Psoriasis affects close to 125 million people worldwide. As part of the 67th session of the World Health Assembly (WHA) in 2014, member states of the World Health Organisation recognized psoriasis as a serious non-communicable disease.ETHealthWorld | June 18, 2019, 19:46 IST

Psoriasis affects close to 125 million people worldwide. As part of the 67th session of the World Health Assembly (WHA) in 2014, member states of the World Health Organisation recognized psoriasis as a serious non-communicable disease.

Impact of psoriasis on quality of lifeWhile the disease may not be life-threatening, many people suffer from delayed or incorrect diagnosis which can result in significant negative impact on patients' health related quality of life (HRQoL). According to the National Psoriasis Foundation almost 75% of patients believed that psoriasis had moderate to large negative impact on their quality of life (QoL), with alterations in their daily activities.

In fact, emerging studies have linked serious medical conditions like insulin resistance, obesity, abnormal cholesterol levels and cardiovascular disease with psoriasis which can severely affect patient’s quality of life.

According to global survey findings, 48% patients shared that psoriasis has impacted their professional life, and 84% have suffered humiliation and discrimination about their condition. People with psoriasis are twice as likely to be depressed as those who don't have it. Studies indicate that nearly 20% of people with psoriasis had some form of depression. Depression can also have a significant impact on quality of life and patients are likely to experience suicidal thoughts or attempt suicide.

While the condition cannot be cured, it can be managed effectively. The introduction of advanced biologics nearly two decades ago has shown significant positive treatment outcomes for psoriasis patients across the globe.

Biologics compared to other therapiesAccording to a 2014 study , for patients receiving eligible treatment for the primary indication of plaque psoriasis, advanced biologics showed higher median effectiveness scores as compared to topical medications. The study also monitored the Overall Satisfaction Score of patients on various kinds of treatment throughout the trial process. The results of Treatment Satisfaction Questionnaire for Medication indicated that while there were generally high levels of satisfaction across treatments, the lowest median scores were seen in those patients receiving topical therapy only or phototherapy. The results were consistent with a survey of Dutch psoriasis patients that indicated higher satisfaction with biologics than with other treatments.

Advanced biologics in psoriasis are unique because they selectively target IL-17A gene without neutralizing IL-17F, or directly affecting other Th17 functions or the Th1 pathway. The specific targeting reduces the potential of adverse effects, in comparison to other available therapies.

Biologics as a treatment option for psoriasis in IndiaAt present, there are no controlled trials or case series on the use of biologics in India. This lack of relevant data from India, means that there is a greater need for treatment guidelines on effective treatment options such as biologics. However, currently psoriasis patients in India may be considered for treatment with biologics, only if they fulfill the eligibility criteria.

To be considered eligible for treatment with any of the licensed biologic interventions, patients must have a psoriasis area severity index (PASI) score of 10 or higher, body surface area (BSA) of 10% or more or a Dermatology Life Quality Index (DLQI) of greater than 10. Additionally, patients are eligible if they develop or are at the risk of developing treatment-related toxicity for therapies such as phototherapy and alternative standard systemic therapy. It may also be the case that certain patients are intolerant or unresponsive to phototherapy and standard, systemic therapy, have a coexistent, unrelated comorbidity preventing the use of certain treatment or suffer from an extremely severe and unstable life-threatening disease.

While there are no existing guidelines in India for the use of the biologics, their use for treatment of psoriasis has shown longer remission periods, which is beneficial for patients. Clinical data also shows that patients with moderate-to-severe psoriasis have achieved positive results with advanced biologics.

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